Method and apparatus for facilitating the processes of parturition



Nov. 6, 1962 o. s. HEYNS METHOD AND APPARATUS FOR FACILITATING THEPROCESSES OF PARTURITION 5 Sheets-Sheet 1 Filed Sept. 2, 1959 m w w m 005973 HEV/VJ Nov. 6, 1962 o. s. HEYNS METHOD AND APPARATU Filed Sept. 2,1959 S FOR FACILITATING THE PROCESSES OF PARTURITION 3 Sheets-Sheet 2Nov. 6, 1962 o. s. HEYNS METHOD AND APPARATUS FOR FACILITATING THEPROCESSES OF PARTURITION 3 Sheets-Sheet 3 Filed Sept. 2, 1959 UnitedStates Patent Gfitice W292 Patented Nov. 6, 1952 METHOD AND APPARATUSFOR FACILITATING THE PROCESSES OF PARTURITION Ocirert S. Heyns, MedicalSchool, Hospital St, .i'ohannesburg, Transvaal, Republic of South AfricaFiled Sept. 2, 1959, Ser. No. 819,323 Claims priority, applicationRepublic of South Africa Jan. 14, 1956 9 Ciaims. (Cl. 128-361) This is acontinuatio-n-in-part of the application filed on January 9, 1957 underSerial No. 633,335, new Patent No. 2,981,255.

The process of parturition is naturally divided into three stages, inthe first of which the cervical orifice of the uterus is caused to openpreparatory to the explosion of the foetus, while in the second stagethe foetus and the uterus, opened during the first stage, are displacedtowards the pelvic floor for the foetus to be expelled through the gapin the floor constituted by the vaginal canal. In the third stage theplacenta is expelled.

The movements of all stages are produced by muscular contractions of theuterus induced automatically, and by movements of the abdominaldiaphragm produced consciously.

The first and third stages and most of the second take place in theabdominal cavity, by which is meant the body cavity the walls of whichare defined from above by the abdominal diaphragm, from below by thepelvic floor and at the sides by the abdominal walls. It has beenascertained that the pressure within the cavity is somewhat aboveatmospheric. The pressure is, of course, variable in that it isdependent upon the movements of the diaphragm, which, in the processesof parturition, is projected downwardly to promote or to induce theprogress of the stages.

It is primarily but not exclusively the first stage with which thisinvention is concerned. The main object is to facilitate childbirth inthe sense that the pain commonly associated with the process (which inthe first stage endures on the average for 14 hours) is lessened andalso in the sense that the duration of the first stage of labour is in asignificant number of cases shortened.

To assist in understanding the invention, reference is made to theaccompanying drawings in which:

FIGURE 1 is a diagrammatic section of the internal feminine organsduring the first stage of labour,

FIGURE 2 is a similar view during the second stage,

FIGURE 3 is a side view of a bed with a patient seated on adecompression chamber during the second stage,

FIGURE 4 is a perspective view of part of the bed shown in FIGURE 3,

FIGURE 5 is a side view of a patient in the first stage of labour, usinga decompression dome,

FIGURE 6 is an underplan view of the decompression dome,

FIGURE 7 is a perspective view of a patient in the first stage, using adecompression suit,

FIGURE 8 is a side view, partly in section of FIG- URE 7,

FIGURE 9 is a perspective view of a harness used inside the suit,

FIGURE 10 is a perspective view of a backing plate used with the suit,and

FIGURE 11 is a side view, partly in section, of another form of suit.

In FIGURES 1 and 2 of the drawings the abdominal cavity 10 is shown,defined from above by the abdominal diaphragm 11, from below by thepelvic floor 12 and at the sides by the flanks 13, the posterior wall 14and the anterior wall 15.

In the advanced stages of pregnancy the cavity 10 is for the greaterpart occupied by the uterus 16.

During the first stage of labour, the spasmodic movement of the uterus16 imposed by its own muscular structure as well as by consciousdisplacement of the diaphragm 11 can cause no significant displacementof the pelvic fioor 12 or of the flanks 13 or of the posterior wall 14of the abdominal cavity; and the forces due to the intermittent changesfrom ellipsoidality to spheroidality of the uterus are thereforepredominantly imposed upon the anterior abdominal wall 15. This isillustrated in FIG- URE 1 where the uterus is shown in dotted lines whenit is spheroidal. Unless that wall is freely distensible, there isevidence that its resistance to these formal changes of the uteruscauses severe pain.

If there be no conscious relaxation of the anterior wall 15, so that thewall is rigid, the whole process of labour is inefiicient and results ingreat sufiering. If such relaxation can be achieved, pain is relievedand the progress of the first stage of labour facilitated, but this isnot always possible to achieve and, even if it is, the anterior wall 15is normally distended by the changing uterus 16 beyond the naturalstretch of the muscles of the abdomen.

In the method of the invention as applied to the first stage of labourthe external pressure on the anterior wall 15 is reduced.

One way in which this is done is to apply to the exterior of the Wall 15a decompression chamber such as the dome 19 illustrated in FIGURES 1, 5,and 6 in communication with a vacuum pump 17 (FIGURE 5) through a pipe18.

It is pointed out that it is of the highest importance that the suctionbe applied to the abdominal region and not to the lower limbs. If thelower limbs be subjected to suction, as would be the case if the patientwere placed in a box which is partially evacuated, circulation of bloodwithin the limbs is seriously impaired. This is due to the inability ofthe vessels in the limbs to return blood to the heart, causingcongestion or pooling of blood in the extremities because of reductionof pressure head. The result is akin to the mechanism occurring in theValsalva experiment, and will induce ischacmia of the brain andunconsciousness and perhaps, if not immediately detected, will causedeath.

The dome 19 is satisfactory since it acts to apply the suction only tothe abdomen and not to the extremities, so that the Valsalva effectscannot occur.

A second way is to encase the patient in a flexible suit as in FIGURES 7et seq. The suit is in the form of a sack 50 made of flexible materialsuch as PVC or polyethylene and with an airtight lighting fastener 51 orlike device extending longitudinally, which enables the suit to beopened up for the patient to don it. The suit is closed at the lowerend, and has a hem 52. at its month which, when the fastener 51 ispulled up, and suction is applied to the suit, is pressed into sealingengagement with the patients chest and back.

The suit is maintained spaced from the patients abdomen by means of aharness 53 associated with a backing plate 54, against which the wings55 of the harness rest. The harness and plate constitute a frame thatsurrounds the medial zone of the patient and is spaced from the abdomen;and which supports the suit.

The harness has a nipple 55 that registers with an aperture 57 in thesuit.

To the nozzle there is connected a suction hose 157 comprising a valve58 that is controlled, through a cable 59, by the patient to set thedegree of vacuum in the suit; and a pressure gauge 69 to show the degreeof vacuum at any moment.

In use, the woman dons the suit and is ensconced in a chair 61 in whichshe reclines at an angle such that the foetal axis is more or lessvertical. She decompresses the suit to the extent necessary to relievepain but not enough to cause discomfort. Between bouts of pain, thepatient may restore atmospheric pressure in the suit.

The suit, being flexible, collapses save where the harness 53 holds itaway from the abdomen, and presses against the limbs 62, which aretherefore kept at atmospheric pressure, so that blood circulation is notimpaired.

The suit of FIGURE ll is like that shown in FIG- URES 7 and 8, butinstead of a harness the suit is kept away from the abdomen by pressurefiuid contained within an annulus 63 formed in the medial zone of thesuit. The fluid-filled annulus keeps the suit spaced from the abdomen,as shown in FIGURE 8.

The posture of the patient during the decompression operation may be ofsome moment. Experiments indicate that while decompression is takingplace the beneficial effects may result if the foetal axis is more orless vertical, so that gravity plays a part. The patient is thereforeplaced in a reclining attitude on a chair 20 the back 21 of which isinclined to the correct angle for this purpose; and the back 21 may bemade adjustable so that the obstetrician can tilt his patient backwardsin order to make it easier to listen to the foetal heart.

Under the effect of the suction the anterior wall 15 distends and isconditioned to distend further when acted on by forces due tointermittent changes of form of the uterus 16. Without conscious effort,therefore, the anterior Wall 15 yields, to avoid or to relieve pain andto hasten the progress of the first stage of labour.

The extent to which the external pressure on the anterior wall 15 isdecreased is such as to promote the result discussed above, whileavoiding undue discomfort.

It is a feature of the invention that the magnitude of the vacuumamounts to a negative pressure of at least 20 mm. of mercury andpreferably over 40 mm. of vacuum. In normal cases a vacuum of the orderof between 40 and 50 mm. may be very suitable. In some cases a vacuum of100 mm. or even 150 mm. may be expedient. In the latter case it may beconvenient to arrange matters so that as a contraction occurs the vacuumis raised to a high level, say 100 mm., and after a short interval, say20 seconds, allowed to drop to a lower level of say 20 mm. Under theseconditions, the duration of the first stage of labour in the majority ofcases has been found to be reduced to several hours with less pain thanis normal.

The applicant has amassed a great deal of experience on the effects ofdecompression on the first stage of labour, since the invention wasreduced to practice. He has established that decompression stimulateslabour even when early and while the contractions are still very weak.This is probably due to a reduction of the forces resisting the changeof shape to spherical form, since, when contracting, a uterus alwaysendeavours to change its flattened ellipsoid shape to round.

Thus spurious, tardy and inertia labours are typically altered toprogressive by decompression, but as soon as decompression is stoppedlabour ceases or is markedly slowed down. The spectacular results are,however, obtained with the ideal irrevocable type of labour.

Results show that 98% of parturients are helped. In 50% the pain oflabour and the amount of it is so trivial as to have become negligible.

When the two factors of duration of the first stage and pain relief aretaken together, analysis shows the following achievement:

The first stage is reduced to half or below the average time in over 70%of primigravidae. There is substantial pain relief in over of labours.

Even in these few cases where there is seemingly no substantial painrelief applicants observations indicate that the parturients are indeedspared suffering, even it, because of the human factor, they do notadmit to it.

Dealing now with the second stage, the wall across which the pressuredifferential is set up is the pelvic floor 12 composed of the levatoresani 22 (FIGURES 1 and 2) gapped at 23, as stated above, by the vaginalcanal 24.

It will be appreciated that the pelvic floor 12 constituted by thelevatores ani 22 differs from the anterior abdominal wall 15 in that itsexterior surface is internal, and also in that it is not continuous butis gapped by the vaginal canal 24. The application of suction to thepelvic floor 12 up to the late first stage of labour will normally notbe made although it might be in cases of uterine inertia; but as thesecond stage proceeds the gap 23 (as shown in FIGURE 2) becomes occludedby the foetal head and the application of suction then permits apressure differential to be built up across what remains of the floor 12after enlargement of the gap 23 by the foetal head; and this pressuredifference acts to facilitate the passage of the foetus through the gap23, a passage which may be further facilitated by a pressure differenceacross the anterior abdominal wall 15, in its lower regions at least, tominimize resistance by the wall to muscular movements of the uterus 16and the diaphragm 11.

The exterior surface of the pelvic floor 12 not being readily accessiblefrom without the body, suction is imposed on it by way of the vaginalcanal 24 and the surrounding soft tissue. In this connection it ispointed out that the tissues surrounding the canal 24 and underlying thefloor 12 are spongy and pervious and that suction applied to the canalshould lower the pressure within the tissues and beneath the floor 12.

During the application of suction, it is advisable that the patient beseated in a reclining position, so that gravity assists the passage ofthe foetus along the birth canal. In the method of the invention, thepatient, when the second stage of labour begins, may leave the chair 20and be transferred to an apparatus which enables her to sit herself upona decompression chamber formed with a port that in use is closed by herbody.

The apparatus illustrated in FIGURES 3 and 4 consists in a bed 25 thehead end 26 of which is pivoted to be capable of being raised to form aback rest, as shown in FIGURE 3. The foot end 27 is inclined downwardlyand can be raised to horizontality and clamped there by a stay 28. Thuswhen the head 26 is raised and the foot end 27 lowered the bed istransformed into a-chair. The head end may be raised and lowered by aleadscrew and nut device 29. The medial portion 30 'of the bed is fixed.It is formed with a hole 31. Underneath is situated the upper end of acylindrical decompression chamber 32, the top of which is gapped at 33to form a port preferably of kidney shape with a soft rubber or.rubberlike rim 34.

With the head end 26 of the bed raised,'the patient sits upon thedecompression chamber, and the rim 34 of the port 33 causes the chamberto be sealed with her body around the pelvic outlet 35 (FIGURES 1 and2).

The decompression chamber 32 is connected by a pipe 36 to a vacuum pump37.

Suction is applied to the pelvic outlet 35 more or less in synchronismwith the uterine spasms which accompany the second stage of labour; thatis to say for periods of between 30 and 60 seconds, at intervals of say60 seconds.

The pulsations of suction are continued until the delivery is imminent.To enable this point to be ascertained the chamber 32 is provided with awindow 39, and an electric lamp 40 is mounted within the chamber.

The head end 26 of the bed is then lowered to bring the patient to arecumbent position, a shutter 41 is slid into place over the hole 31 anddelivery is effected.

Experience has shown that the results of the method of the inventionduring the second stage of labour, are remarkable. The patient need notbear down, but the time taken for the foetus to move down the birthcanal is materially reduced, if she does. Indications are that somebirths requiring instruments will proceed normally, and that somecaesarean operations will be rendered unnecessary.

The handling of the third stage of labour is akin to that of the secondsince again the method of the invention is to apply a difierentialpressure across the pelvic floor to assist in the extraction of theplacenta. After delivery the shutter 41 is withdrawn, the head end 26 ofthe bed is raised and the foot end 27 lowered, to bring the patient intoa sitting posture on the port 33, and suction is applied. It is foundthat by the method of the invention the third stage of labour is in mostcases reduced to a period of the order of one to three minutes, afterthe placenta has separated.

A highly important feature of the invention is that, after extraction ofthe placenta, the suction applied tends to cause strong contraction ofthe uterus and thus to avoid post-partum haemorrhage. Experience hasshown that even where haemorrhage has occurred the effect of suction isto stauch the flow of blood and that it has not been necessary toadminister oxytoxics.

It is scarcely necessary to say that in practice the dome 19, or suit 5%and the chamber 32 are each one of a set, to cater for women ofdifferent sizes. in the case of the chamber 32, the upper partcontaining the rim 34 may be replaceable by any one of a set to vary thesize of the rim.

I claim:

1. A method of relieving pain during the process of parturitioncomprising the steps of applying suction to the entire abdominal zone ofa parturient in a reclining position during the first stage of laborthereof so as to distend the abdominal wall outwardly, and maintainingthe remainder of the body of the parturient including the lower limbs atsubstantially atmospheric pressure.

2. The method of claim 1 in which the suction is applied intermittently.

3. The method of claim 2 in which the suction is applied while theparturient is so reclining that the foetal axis is substantiallyvertical.

4. The method of claim 2 in which the suction applied is above 20 mm.Hg.

5. The method of claim 4 in which the suction applied is to the order of150 mm. Hg.

6. The method of claim 2, followed by the steps of applying pulsationsof suction to the pelvic outlet during the second stage of labour,substantially synchronously with the uterine contractions; andcontinuing such pulsations substantially up to the point of delivery.

7. The method of claim 6 followed by the steps of applying suction tothe pelvic outlet, after delivery to extract the placenta.

8. Apparatus to relieve pain during childbirth comprising a flexiblesuit defining a sack having a cavity therein and provided with a mouthto receive the body of a parturient up to and under the arms thereof,fastener means extending longitudinally of said sack to provide ingressand egress of said parturient therein as well as providing an airtightseal, means disposed at said mouth to seal same around the back andchest of said parturient, rigid frame means medially disposed withinsaid sack to maintain said suit spaced from the abdomen of saidparturient to form a cavity therebetween, said frame means including aharness having wings and a backing plate having an angular disposition,said wings of said harness having an angular configuration corressondingto that of said backing plate so that said harness snugly abuts againstsaid backing plate, the angular disposition of said backing plate beingsuch that when the parturient is in a reclining position the foetal axisis substantially vertical, and suction means operatively connected tosaid suit to apply suction to said cavity to distend the abdomen of theparturient while the part of said suit around the parturients legscollapses therearound during the application of suction to maintain thelegs at substantially atmospheric pressure.

9. Apparatus according to claim 8 in which said suction means includeshose means communicating with said cavity, valve means disposed in saidhose means, and manual operating means operatively connected to saidvalve means which is controlled by the parturient to apply the desiredamount of suction in dependence upon the amount of pain.

References Cited in the file of this patent UNITED STATES PATENTS1,498,430 Doerfler June 17, 1924 2,490,395 Wilm Dec. 6, 1949 2,917,050Kenyon Dec. 15, 1959 FOREIGN PATENTS 565,434 Germany Nov. 30, 1932952,782 France May 9, 1949

